Long-term mortality following injury in working-age adults: a systematic review

Priorities for prevention activities and planning for services depend on comprehensive knowledge of the distribution of the injury-related burden in the community. The aim of this systematic review was to quantify the effect of being injured, compared with not being injured, on long-term mortality in working age adults. Cohort studies were selected that were population-based, measured mortality post-discharge from inpatient treatment, included a non-injured comparison group and related to working-age adults. Data synthesis was in tabular and text form with a meta-analysis not being possible because of the heterogeneity between studies. Eleven studies met the inclusion criteria. All studies found an overall positive association between injury and increased mortality. While the greatest excess mortality was evident during the initial period post-injury, increased mortality was shown in some studies to persist for up to 40 years after injury. Due to the limited number of injury types studied and heterogeneity between studies, there is insufficient published evidence on which to calculate population estimates of long-term mortality, where injury is a component cause. The review does suggest there is considerable excess mortality following injury that is not accounted for in current methods of quantifying injury burden, and is not used to assess quality and effectiveness of trauma care.     

Age and gender differences in risk-taking behaviour as an explanation for high incidence of motor vehicle crashes as a driver in young males

Risk-taking behaviour has been identified as a possible explanation for the high incidence of motor vehicle crashes involving young male drivers. This study examines the extent to which differences in risk-taking behaviour explain the differential crash rates by age and gender. A random sample of 689 adults aged 17-88 were selected from motor vehicle license holders within randomly selected geographical areas across Queensland. Participants completed a questionnaire covering their attitudes towards driving behaviour and general risk-taking behaviour, selected demographic characteristics and self-reported history of road crashes as a driver. Univariate analysis showed that males scored higher means than females in driver aggression and thrill seeking and in their general risk acceptance. Multivariate logistic regression analysis indicated that males were twice as likely (OR 2.46, CI 1.59-3.83) to have reported at least one crash as a driver compared to females and nearly three times as likely (OR 2.88, CI 1.84-4.49) to have reported two or more crashes. Drivers aged 17-29 were also twice as likely (OR 2.31, CI 1.10-4.19) to have reported at least one crash when compared to those aged over 50 years. When risk-taking behaviours were introduced into the logistic model the odds of males (OR 1.70, CI 1.29-3.30) or 17-29 year olds (OR 1.30, CI 0.93-3.91) being involved in at least one crash substantially reduced. An increased risk of a crash as a driver can, in part, be explained by the age and gender differential in risk-taking behaviour. The challenge for public health professionals is to determine suitable strategies to modify risk-taking behaviour in young or male drivers.     

The stock market and investment

Changes in stock prices have substantial explanatory power forU.S. investment, especially for long-term samples, and evenin the presence of cash flow variables. The stock market dramaticallyout-performs a standard q-variable because the market-equitycomponent of this variable is only a rough proxy for stock marketvalue. Although the stock market did not predict accuratelyafter the crash of October 1987, the errors were not statisticallysignificant. Parallel relationship for Canada raise the puzzlethat Canadian investment appears to react more to the U.S. stockmarket than to the Canadian market.     

Indicators of injury burden: which types are the most important?

Injury indicators are used for monitoring the impact of injury prevention initiatives on the population burden of injury. The object of the present study was to identify the types of injury responsible for the major component of the population health burden of injury in a large cohort in Manitoba, Canada. Injury cases (ICD-9-CM 800-995) aged 18-64 years were identified from all Manitoba hospital data between 1988 and 1991. Morbidity data were obtained from hospital discharge abstracts 12 months prior to date of injury and for 12 months post-injury. Outcomes for individuals were calculated as the difference pre- and post-injury in hospital inpatient days. Death outcomes in the 12 months post-injury were obtained by linking the cohort with the population registry. Summed outcomes across the population were stratified into injury types based on the International Code of Diseases (ICD) code of the index injury. Outcomes were also stratified by injury severity score categories where the injury severity score was obtained using ICDMAP-90. When ranked by contribution to the cohort's cumulative hospital inpatient days in the 12 months post-injury, the six most common ICD subchapter groups accounted for 65% of the total inpatient days. These six injury types also accounted for 62% of the total number of deaths in this cohort in 12 months after injury. The suggested injury types to use as indicators of burden include fracture of the lower limb, fracture of the head and neck, poisonings, intracranial injury, fracture of the upper limb, and fracture of skull.     

How well do anatomical-based injury severity scores predict health service use in the 12 months after injury?

There is an acknowledged need for valid and reliable injury scores, suitable for use at the population level, which can accurately predict the long-term outcome of injury. The objective was to quantify the extent to which the abbreviated injury severity score (AIS) and the functional capacity index score (FCI) predict use of health services in the 12 months following an injury event. A cohort of injured people (ICD-9-CM 800-995) aged 18 - 64 years was identified from Manitoba hospital discharge abstracts from January 1988 to December 1991. For each member of the cohort whose injuries could be mapped to an abbreviated injury scale unique identifier, a maximum AIS (maxAIS) and a maximum FCI (maxFCI) were obtained. The cohort was linked with hospital discharge abstracts, physicians' claims and deaths from the population registry for the 12 months following injury. Negative binomial regression was used to model the relationships between the severity scores and the three outcome measures, while controlling for potential confounding variables. In total, 20 677 (97%) eligible cases were identified, of which 16 834 (81%) could be assigned a maxAIS and 15 823 (77%) a maxFCI. MaxAIS and maxFCI were significantly associated with total days in hospital following injury, but explained little of the variation in any of the health service use outcome variables (maxAIS, partial pseudo r2 ranging from < 0.001 to 0.041; and maxFCI, partial pseudo r2 ranging from < 0.001 to 0.018). It was concluded that anatomical damage is only partly responsible for long-term injury outcome. Additional variables would need to be included in predictive models of health outcomes of injury before these models could be reliable.     

Joint product signals of quality

Summary The relationship between product quality, signals, and the firm's optimal pricing policy has been given much attention in economics. The literature is extended in this paper by considering the signaling problem of a firm that jointly produces two commodities—one of known quality to consumers (a search good) and one of unknown quality (an experience good). The model presented employs a stylized reputation function, a linear cost structure, and linear demand schedules to produce two interesting insights. First, the search good's price can potentially be used as a signal of the quality of the experience good. Second, the price of a search good will depend upon whether it is jointly produced with another search good or an experience good or whether it is produced in isolation by a single product firm. Furthermore, evidence from a paper on gasoline pricing seems to support this contention.     

The evolution of human cooperation

We argue that cooperation is instinctual. Human cooperation conferred advantages to individuals in the ancestral environment in which evolution occurred. Explanations of the evolution of cooperation for any species (human, pre-human, and non-human) have to be consistent with the biological, physiological, and environmental constraints that existed in the ancestral environment during which evolutionary selection occurred. Our explanation is consistent with: (1) the anatomical evolution of humanity; (2) the paleontological and chronological evidence; and (3) modern biology.     

Long-term economic consequences of hedge fund activist interventions

Review of Accounting Studies - We examine the long-term effects of interventions by activist hedge funds. Research documents positive equal-weighted long-term returns and operating performance...     

Community-based programmes to promote use of bicycle helmets in children aged 0-14 years: a systematic review

Hospital-based research has shown that wearing a helmet reduces the risk of head injury in bicycle riders. These studies have provided the impetus for community-wide interventions to increase the numbers of cyclists who wear helmets; however, the effectiveness of such programmes is undetermined. This study employs extensive search strategies to review the scientific literature to establish the effectiveness of community-wide programmes to increase helmet use among cyclists. Thirteen community-wide intervention studies using substantive methodologies were located in 16 published papers. The community-wide interventions include mandating helmet wearing, education campaigns, distribution of free or subsidized helmets or, more frequently, combinations of all of these methods of influence. All studies reported success in influencing helmet wearing across communities. However, none of the studies reveals enough detail of the mix or techniques employed in the interventions to replicate the interventions. While it is encouraging that all of the studies showed positive results, the way forward for further implementation of helmet wearing is for adequate documentation of successful interventions.     

Theory versus Application: Does Complexity Crowd Out Evidence?

Donald F. Gordon hypothesized that mathematical complexity in economics is inversely related to operational ism. Here we (i) operationalize Gordon's hypothesis, (ii) test for the significance of trends in complexity for the American Economic Review, Economic Journal, Journal of Political Economy, and Quarterly Journal of Economics, and (iii) test Gordon's hypothesis hy conducting analyses of the contents of articles from the American Economic Review (AER), as well as the contents of articles citing the AER articles. The results do not refute the hypothesis that complexity crowds out operationalism in economics. Additionally, the presence of significant, positive trends toward complexity suggests that the magnitude of the crowding out is on the rise in these journals.